Impact of early elective tracheotomy in critically ill patients

INTRODUCTION: Tracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience. OBJECTIVE: To determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality. METHODS: Retrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation) and late tracheotomy group (tracheotomy performed after day seven). The outcomes of the groups were compared. RESULTS: In the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p < 0.001), duration of intensive care unit stay (10 days vs. 28 days; p = 0.001), and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p = 0.001). CONCLUSION: Early tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy.

引言：气管切开术是重症监护病房（Intensive Care Unit, ICU）收治的重症患者中最常实施的外科手术之一。尽管已有数十年临床经验，气管切开术的最佳时机仍存在争议。研究目的：明确对重症患者实施早期气管切开术，对其机械通气时长、重症监护病房停留时长、总住院时长、并发症发生率及死亡率的影响。研究方法：本研究为回顾性观察性研究，纳入该院某重症监护病房连续5年内接受择期气管切开术的病例。将患者分为两组：早期气管切开组（机械通气第1日至第7日（含第7日）实施气管切开术）与晚期气管切开组（机械通气第7日后实施气管切开术），并对两组的结局指标进行比较。研究结果：早期气管切开组患者的机械通气时长（6日 vs. 19日；p<0.001）、重症监护病房停留时长（10日 vs. 28日；p=0.001）以及呼吸机相关性肺炎（Ventilator-associated pneumonia, VAP）发生率（1例 vs. 44例；p=0.001）均较晚期组出现具有统计学意义的显著降低。研究结论：早期气管切开术对该院重症监护病房收治的重症患者具有显著的积极影响。本研究结果支持将风险获益分析倾向于早期气管切开术的临床趋势。